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Home My WebLink About0029 CRANBERRY RIDGE ROAD - Health � � �vas��..� �� f`�o 14E Joe( �tn I �i b I I � I 4 I � I I i S M E A No.2453LY j UPC 12934 emeadcom m Trade In USA eD�Y� I FORESTRYABLE INITIATIVE Certified Fiber Sourcing ww affprogrenwrg TOWN OF BARNSTABLE , t.00ATION. 9 ere., 6 ea!j i JA e- R A SEWAGE #. -VILL.AGE�4mar- A' s- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO._I I k e L e a r c 4 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) S tnj(:� 1 fon (size) l 1 ;4 3 7 NO. OF BEDROOMS y BUILDER OR OWNER Ro ip er-IL t I>C PERMITDATE: COMPL CE DATE: 4 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by `T EA �` � i 1•-D 37 � B•C S3' TOWN OF BARNSTABLE LOCATION SEWAGE # 97V"* VILLAGE ASSESSOR'S MAP & LOT 030 D Ca INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY X2,6-0 LEACHING FACILITY:(type) S (size) 11 .a0 NO. OF BEDROOMS_ PRIVATE WELL O PUBLI ATER BUILDER OR OWNER DATE PERMIT ISSUED:' DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No o' U3v /off / Fxs.....3.Q........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Bi-nVn!3ttl Wnr1w Tomitrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: p ......£�� - Y'N��--- .-- -------- -- ........................ ............. = ......•---....----•---------------...----..... Lo &t-Address or Lot No. t. .......... --------- •---------------...... Ow er � ^ n n�44'd'ress e �` i[/��lInstaller UType of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms....... .................._--__--.----Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building No. of ersons---------------------------- Showers t� YP g ---------------------------- P ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- -- W Design Flow............................................ga ons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter---------------- Depth................. x Disposal Trench—No- -------------------- Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area...........:.`...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date...........................=............ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ fx, Test Pit No. 2________________minutes per inch Depth of Test Pit__._._..___..._____. Depth to ground water_........._..._....._... 94 •---•----•--------------•----------••----•-•------••-----•-••••--•••--•-•-•-•------•............--••.......................................................... 0 Description of Soil........................................................................................................................................................................ V ....•--•------------------•-------......-•-----•--...----•-•---•---•--•---------•-•-----......._..----------...---------------------------------•-------•----------------------------••--•-•---------••- W - -- --------- - U Nature Repairs r A terat ons=Answer when applicable. ....... _ .. •........ •.•• . •-• --. Agreement-. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant been issued by he b rd of health. {�..... 9 Signed ..... . .. V. .................................................................. Dace Application Approved By ........ 3 ....... Dare Application Disapproved for the following reasons: ..... . .. .. .... ....................... .. .................. -- ......................... . .................................. ---------------------------------------- Permit No. .... .. ,�Q'�...----------_------ Issued ............... . �t....... Dace 030 No.` y:.: (22, FEB....�`<2........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for UiuVv_ga1 Works Cnunutrnrtiun Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Loea b - \ddress or Lot No. .....-.-. .._.�: � D ------ ------------------------------------------------------ --........_...------. .-...... 1 fin/ Ow�er{%I Addre�s/s� ` WW1 ,! t!l�vCV..!.--�.... _ti�S ��.._.-`�- ��</��L�^� A( ..... ^-•--•-- •----•r`� a �-....._ Installer U Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms______�__________________ __ Expansion Attic ( ) Garbage Grinder ( ) --------------------•- ----- No. of persons---------------------------- Showers —per., Other—Type of Building p ( ) Cafeteria ( ) a' Other fixtures _______________________________ _ _ W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter...------------- Depth.............. x Disposal Trench—No_ ____________________ Width_------------------ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •----------------------------•------------------•-----....-•---•-•--------.-._.......-..-....------...-•----------•-------•-------•_•--....•...------------- ODescription of Soil........................................................................................................................................................................ x M x ••-•••-------------------- -- -------------------------------------------------------------------••------- L -'�i U Nature of Repairs or Alterations—Answer when applicable�_Arr� -- ---- ? cs--mot Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance`has been v 1 issued ., h�ard of healt..h... � �-9— q `� Signed ---------Y,2. ( !� � ..... . � . ... ....- ... ...-.Date..........:...... APPlication Approved BY - ...---� t ..... # ............. .9.-SIC U e Date Application Disapproved for the following reafonf: ..... ..... .......... ...................... .. .. . . - -.............:-.....-...--...... - - - --- ---------- ---------.-----------------------------------------------.- ------------------------.--..----..----------------------------------- �y � Dace Permit No. `1 L,(-.7. ------------------------ Issued ........--...-..-......................... -.............. . - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE TQltifirate of 11 ampltanve TI ,S IS TO CER jIF-�, That the Individu� 1 Sewage Disposal System constructed ( ) or Repaired ( �'� by ...... ... .. . .. Y...:- ` . / - ...... �...... - ..... .... /—�• Installer at .......... .. ........... ...... ....... .. .. .. /. ��+-- ... --/--------------------------------------------------- provisions chas been installed in accordance wi the of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -----'.I.. ._�j . .'�—....... dated ............................-......--------.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � o ....DATE........ Inspect.. ... � --- -------- -------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE........ .. �..... � � rk� �unu#r�tiun �rrnti� Diu uuttl-emu Permission is hereby granted....... -----La4 "/-. to Construct ( ) or Repair ( 4-fanIndividual Sewage Disposal System at No............ - ,-.� 'Ji°A � F `� �"� �) � iStreet Nc.� as shown on the application for Dis osorks Construction Permit o-!_r_:` Dated___.._^ L.-.... PP ai W P s SUD c, ,.. ................................. `•' --------------------------------------------------•-- �j V Board of Health DATE................... --- -•!• FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS